Provider Demographics
NPI:1679905764
Name:MEADOWS, COLEMAN D (DDS)
Entity type:Individual
Prefix:
First Name:COLEMAN
Middle Name:D
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE A105
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1704
Mailing Address - Country:US
Mailing Address - Phone:858-452-5520
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE A105
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1704
Practice Address - Country:US
Practice Address - Phone:858-452-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist